Playful Pedagogies: Embedding Mental Health and Wellbeing in Primary Schools
ISBN: 978-1-83797-245-6, eISBN: 978-1-83797-242-5
Publication date: 21 August 2024
Abstract
School-based social and emotional learning (SEL) programmes aim to improve pupils’ decision-making, emotional regulation and social skills. A body of international evidence has demonstrated the effectiveness of this type of early intervention for improving both mental health and educational outcomes. Nonetheless, if evidence of a programme’s effectiveness is to be usefully applied, educators need to know not only what works but how, and this is the theme of the chapter. Clearly, collaboration and consultation with teachers are essential to properly develop school-based provision. This case study introduces the Book of Beasties SEL intervention (which is based on a mental wellness card game and linked wellbeing activities) and charts its implementation in a primary school setting. Challenges and facilitators associated with embedding the programme are considered through the first-hand reflections of a primary school teacher who was also the delivery agent. Practical recommendations for a smooth and effective implementation, as well as pitfalls to avoid, are provided and can be applied to a local setting.
Keywords
Citation
Jayman, M. and Field, N. (2024), "Playful Pedagogies: Embedding Mental Health and Wellbeing in Primary Schools", Jayman, M., Glazzard, J., Rose, A. and Quickfall, A. (Ed.) The BERA Guide to Mental Health and Wellbeing in Schools: Exploring Frontline Support in Educational Research and Practice (The BERA Guides), Emerald Publishing Limited, Leeds, pp. 99-116. https://doi.org/10.1108/978-1-83797-242-520241006
Publisher
:Emerald Publishing Limited
Copyright © 2024 Michelle Jayman and Naomi Field
Increasing the role of schools in the provision of mental health services for children1 has the potential to improve early intervention and access to timely support. This basic premise underpins the UK government’s current expanding access to mental health care strategy (Department of Health [DoH] & Department for Education [DfE], 2017; NHS, 2019). SEL programmes delivered in school settings aim to improve pupils’ decision-making, emotional regulation and social skills. Acquisition of these competencies can positively influence a range of outcomes for children. A body of evidence has demonstrated that school-based SEL interventions can not only improve pupils’ wellbeing but also their mental health and behaviour (Sorgenfrei & Clarke, 2021). Conversely, weak SEL skills are linked with poorer mental health and lower academic attainment (Education Endowment Foundation, 2023). Despite robust evidence supporting the positive effects of school-based programmes (see https://guidebook.eif.org.uk/), there are also multiple options available to schools and many interventions either lack evidence or have demonstrably weak outcomes. In terms of commissioning decisions, it is the responsibility of state-funded schools to ensure that they are ‘helping pupils to access evidence based early support and interventions’ (Brown, 2018, p. 6 [emphasis added]). Evidently, schools should carefully consider which interventions are chosen based on the strength of the evidence –although this is not always applied in practice (Cooper, 2011). Beyond commissioning decision-making, the process of embedding mental health interventions in schools presents numerous challenges and is influenced by factors operating on multiple interacting levels. These circumstances are of primary interest in the current chapter.
Teachers as Intervention Delivery Agents
Alongside the expansion of mental health provision in schools there has been a growth in the number of teachers involved in the delivery of psychosocial interventions. Teachers are experts in understanding their classroom and the school environment and have a trusted relationship with pupils which implies their inherent suitability. However, as described earlier (see Chapter 1), mixed findings have been reported concerning the success of psychosocial interventions delivered by teachers (Cefai et al., 2021; Wigelsworth et al., 2020). A systematic review by Franklin et al. (2017) examined the effectiveness of school-based interventions delivered by teachers on internalising (i.e. emotional) and externalising (i.e. behavioural) outcomes. The authors’ findings supported existing literature showing that teacher-delivered interventions were beneficial for pupils; however, interventions were more effective for reducing internalising difficulties (e.g. anxiety) compared with externalising difficulties (e.g. hyperactivity), with greater improvements shown among female recipients. As Durlak and DuPre (2008) insisted, implementation quality potentially influences intervention effects more so than the programme itself, and variability in practice leads to differential outcomes. Crucially, careful consideration of process issues can help determine whether an intervention’s effectiveness, or otherwise, is attributable to its content and design or rather to implementation factors (Lendrum & Humphrey, 2012). In addition, specific insights, for example, teachers’ acceptance and perceived value of an intervention can help inform programme development and future delivery iterations.
Implementation Matters
Blase et al. (2012) argue that if evidence of a programme’s effectiveness is to be usefully applied, educators need to know not only what works, but how. Moreover, they insist that implementation science is concerned with exactly how interventions are implemented and sustained in ‘very messy real-world settings’ (2012, p. 13). Potential implementation variables have typically been conceptualised within ecological frameworks which contain the intervention, implementer, organisation and external environmental levels (Collier-Meek et al., 2019). For example, Durlak and DuPre’s (2008) implementation framework for universal SEL interventions has been widely accepted and applied on an international scale. However, there is a dearth of research on implementation processes for targeted interventions – despite their increasing use in school settings (Evans & Bond, 2021). Arguably, due to their specific nature, targeted interventions require implementation models which are able to capture more idiographic aspects. Nonetheless, the requirements for effectively implementing any intervention depend on a constellation of factors because local contexts can differ widely (Durlak & DuPre, 2008).
In their thematic synthesis of barriers and facilitators for targeted interventions, Gee et al. (2020) identified several recurrent factors. Intervention acceptability, or social validity – the extent to which people receiving or delivering an intervention consider it to be appropriate and valuable – was noted as particularly important for pupil attendance and engagement. Pertinently, small group delivery was identified as contributing to high acceptability, perhaps due to the mutual support and sense of belonging this particular modality has the potential to foster. Although the risk of stigma from peers within the school community was voiced, participating in a school-based intervention was seen as less stigmatising than accessing external mental health support services. In related research, Han and Weiss (2005) proposed that teachers’ acceptability of an intervention significantly influenced their interest and willingness to facilitate it and the degree to which they adhered to intervention fidelity.
In line with extant literature, Gee et al. (2020) found that skilled facilitation of interventions was crucial to successful implementation. The provision of a clear and easy-to-follow manual and good-quality supporting materials were identified as essential delivery tools. The importance of high-quality training for delivery agents and ongoing supervision to support intervention fidelity was also emphasised. Adherence to prescribed programme manuals has been shown to be low for several teacher-led psychosocial interventions. For example, in one study, only 47 per cent of core content was delivered satisfactorily as intended (Gillham et al., 2007). Conversely, interventions that are expected to be led by school staff have been criticised for failing to account for teachers’ time, the added pressure and the ability of delivery agents to equally sustain their commitment to a manualised programme (Taylor et al., 2014).
As Ruffolo and Fischer (2009) have pointed out, protecting staff time for mental health training and supervision can be challenging in school settings and requires dedicated funding and leadership support. Nonetheless, without specific training, mental health misinformation and biases can be generated creating barriers to timely interventions and appropriate referral. This raises concerns regarding the accuracy of procedures used to identify students for whom interventions would be suitable. Although Gee et al. (2020) found that programme recruitment strategies which relied on referrals from school staff were generally effective, there were some concerns regarding staff capacity to identify all pupils who could potentially benefit from specific interventions. Pertinently, research by Oros (2016) highlighted the risk of iatrogenic harm to pupils as a result of inappropriate group composition which is linked to poor referral systems.
More broadly, positive relationships between staff delivery agents and other staff members were found by Gee et al. (2020) to facilitate smoother implementations. For example, running sessions during the school day will disrupt pupils’ regular timetable, so securing ‘buy in’ from colleagues who may be indirectly impacted by the intervention – alongside a clear endorsement from the school’s senior leadership team – can strongly assist the implementation process. Worryingly, however, limited attention to implementation strategies and poor allocation of resources have been widely reported by school staff (Education Support, 2023). The urgent need to align the priorities of both the education and healthcare systems to facilitate the successful implementation of school-based mental health interventions is strongly supported by the literature.
Accessing Teachers’ Views on School-Based Services: ‘We have a duty of care, not a duty of cure’
Research by Shelemy et al. (2019) on mental health provision in schools, highlighted how training programmes need to evaluate their acceptability to teachers and focus materials on teachers’ needs. More research is required to better understand poor adherence to manualised programmes and identify ways in which teachers can be supported to deliver high-quality content in the classroom. Effective and engaging training for teachers can only be designed with a thorough knowledge of what school staff need and would like (Reinke et al., 2011). Findings from Shelemy et al. revealed that teachers primarily perceived their role in mental health provision to be educational and preventive; although in reality demands were often much higher (see Chapter 1). Aligning with their Tier 1 responsibilities, respondents expressed their preference for training to focus on prevention and how to educate pupils about mental health before difficulties arose. Crucially, the need to also educate parents about mental health was voiced. Similar to previous studies (e.g. Gee et al., 2020), better communication with external Child and Adolescent Mental Health Services (CAMHS) was identified as highly desirable, along with guidance on how to develop an effective whole school approach (WSA). Also in line with previous authors (e.g. Vieira et al., 2014), Shelemy and colleagues found a rousing demand from school staff for discussions of real-world case studies and practical advice, and to this end the remainder of the chapter is dedicated.
Book of Beasties: A Teacher-Led Psychosocial Intervention - Naomi Shares Her Views as an Experienced Teacher
As a teacher with over 20 years’ standing in the classroom, I have seen first-hand the outcomes for pupils who struggle to articulate their feelings and find emotional regulation challenging. It is abundantly clear to me that those who learn to use emotional intelligence in their interactions and to self-regulate develop better relationships, have higher confidence and self-esteem, and are better equipped to navigate the emotional ups and downs of adolescence. Early intervention is key. Whilst Head of Year 7, I noticed that educational gaps widened during the transition process for pupils with difficulties managing their emotions, and as a result, they fell further academically and socially behind their peers. This led me to take up a part-time role in a primary school where I could observe more closely the social and emotional progress of children during the crucial primary years. It is here that I delivered the Book of Beasties intervention to two groups of year 4 and year 5 children (aged 8–10).
Book of Beasties is a psychosocial intervention predominantly delivered in schools for children aged 6–11, and underpinned by the ethos that every child should have the confidence to talk openly about their emotions and mental health. The aim of the intervention is to de-stigmatise and promote mental health and raise children’s emotional literacy. This fits well with the health and relationships curriculum in England (DfE, 2019, p. 31) which states that by the end of primary school children should know ‘how to recognise and talk about their emotions, including having a varied vocabulary of words to use when talking about their own and others’ feelings’ and ‘how to judge whether what they are feeling and how they are behaving is appropriate and proportionate’.
School staff are trained to deliver the one-hour Book of Beasties’ sessions to small groups of children (approximately 5), referred by teachers, over five consecutive weeks. Book of Beasties is based on a traditional card game and an accompanying manual includes lesson plans for guidance. Although core elements of the game are standard, there is flexibility to adapt the sessions to suit the unique needs and preferences of each group. Players are introduced to the characters of the Beasties through a story which provides a backdrop to the game. There are 10 ‘beasties’ – each one reported to have characteristics, for example, lack of energy, low self-confidence, brain fog, or self-consciousness (see Fig. 6.1) which are associated with emotional difficulties (e.g. anxiety or depression). The objective of the game is to help as many beasties as possible overcome their worries by collecting special cards depicting ‘items’ that can be of assistance – Item cards prompt activities, for example, the ‘bellows’ help with calmer breathing (see Fig. 6.2). Children take it in turns to flip a card over from the pile placed in the centre and are encouraged to discuss how they might be feeling before play commences and to discuss any issues as they arise. Item cards also support socio-emotional learning through creative tasks and physical movement: sensory-focused activities – yoga, origami, arts and crafts and mindfulness exercises – are built into the game and allow children to explore different wellbeing techniques. For example, as a fun way of experiencing the benefits of deep breathing, origami boats are made by players to race using their breath to blow them over the finish line. Likewise, simple yoga poses are practised, giving children the chance to experience the wellbeing benefits of light relaxation and mental calmness.
Insider View: Naomi Shares Her Experience as a Teacher Delivery Agent
Fundamental to the delivery of the Book of Beasties intervention is allowing the conversation to lead the session. Successful facilitation of the game lies in allowing players to be in the driving seat and for adults to give time for ideas and opinions to be fully expressed. According to Weisberg et al. (2013), guided play with adult scaffolding is more effective for a range of learning outcomes (including socio-emotional development) than didactic or free-play pedagogies. Remaining curious and offering gentle prompts to help players think through problems and solutions is where the intervention displays a simple power. Children are encouraged to discuss why the Beasties may be feeling the way they do, what might have happened to them in their day to make them feel like that and whether they themselves, or a friend, have ever felt this way. These conversations lead naturally into a discussion about why the solutions might help, for example, what does it feel like to take deep breaths? Why might that help us if we are feeling worried? In this way, the guided play initiates positive conversations with and between children about their thoughts, feelings and associated behaviours. Not only do intervention recipients build their knowledge of strategies to promote good mental health, but they also develop the ability to transfer ideas of mental wellness from character- to-peer-to-self across a variety of contexts. Research suggests that imaginative play is positively linked to emotional regulation and coping skills, and children are better equipped to understand situations and respond appropriately in real life when they have experienced similar encounters through play (Blair & Raver, 2012; Fisher et al., 2011).
Book of Beasties normalises the conversation around mental health by giving children a language and promoting an acceptance of all emotions. It teaches empathy and celebrates diversity by emphasising strength and difference. During the time I delivered this intervention, I witnessed an improvement in peer relationships, and in the ability to listen to others’ opinions. Undoubtedly, confidence in discussing emotions, especially those that make us feel uncomfortable increased and children became adept at being able to suggest techniques to help the Beasties, and more importantly themselves and their loved ones. The children loved the game. Their class teachers spoke about how they looked forward to it, and their classmates benefited from being taught some of the strategies in the playground. A wealth of evidence supports the notion that children are more likely to learn and benefit from any intervention when they are engaged and having fun – in interactive environments which invite them in and contain content they find meaningful (Chi, 2009). Preliminary research on the Book of Beasties found that recipients had benefitted in terms of socio-emotional development, for example, greater emotional awareness and pro-social behaviour (Jayman & Ventouris, 2020).
I have also run this intervention in my secondary school – with a group of Year 7 children (aged 11) struggling with the transition from primary to secondary. Results in this context were similarly excellent – with children reporting how useful the strategies were, how beneficial they felt it was to learn about wellbeing, how newly confident they felt with peers – and one pupil admitting that attending the Book of Beasties sessions was the reason they felt better about coming to school. Further formal evaluation of the intervention is ongoing.
As a teacher, I know that the reality of working in schools is that you are often required to be reactive to the mental health problems in front of you. Yet, I am also acutely aware of the need to be proactive in our approach to wellbeing and embed principles so that the fabric of school supports happiness and wellbeing. That is how children will learn and flourish, and this is what a health-promoting school looks like. Book of Beasties offers both the opportunity to react to the varying needs of children in our classrooms, but also proactively educate children about mental health before problems arise. This type of preventive intervention supports teachers in fulfilling their duty of care, while mitigating the risk of a duty of cure arising . It offers a simple, effective and accessible toolkit of strategies that enable children to start managing their own wellbeing – developing skills that they can continue to build and develop as they grow.
Embedding Preventive Interventions Within a Whole School Approach
The senior leadership team at my primary school place significant value on activities that support the development of social skills and nurture wellbeing. Consequently, there is an acceptance among classroom teachers of the value of interventions both at a universal and targeted level, and an understanding that the mental health of children is every adult in the school’s responsibility. Parents are similarly supportive. Therefore, the Book of Beasties intervention was welcomed, and implementation was supported at an ideological and practical level. Buy-in from staff and parents and a clear endorsement from the senior leadership team, as previously noted (Gee et al., 2020), are key facilitators for implementation success. Interestingly, while primary school parents were supportive, some parents of secondary-age pupils displayed a reluctance for their children to receive the intervention. This suggests that further work is needed in normalising the conversation around mental health with older children.
Book of Beasties is easy to implement and requires only a space to play and simple materials such as pens, paper, straws and balloons. I attended online training for delivering the game and was provided with a useful lesson-by-lesson guide on how to facilitate sessions. Supporting materials were comprehensive with clear guidance. Quality resources are crucial for skilled facilitation which, in turn, increases the likelihood of successful outcomes (Gee et al., 2020). Moreover, the training emphasises the flexibility of the game and gives suggestions for adaptations that can be made to allow the sessions to develop organically in response to the children’s lead. This enables children to feel they have ownership of the play as it progresses and allows for a more authentic experience. It also permits the delivery agent more flexibility in their commitment to a manualised programme which can be difficult to sustain (Taylor et al., 2014).
Part of the appeal of Book of Beasties is that anyone in school can deliver it, and there is no requirement to be a qualified mental health professional. However, teaching staff often feel they lack the training and sufficient knowledge to deal with mental health issues. Therefore, care should be taken when selecting or inviting a member of staff to be the delivery agent. Confidence in discussing a range of emotions and their impact on behaviours, and the flexibility to adapt sessions as they unfold are the key competencies needed. This aligns with findings from Shelemy et al. (2019) and Reinke et al. (2011) that emphasise the need for quality training programmes which take into account teachers’ specific needs, the acceptability of the intervention to them and their responsibility for delivery.
The Book of Beasties Legacy
Although Book of Beasties is a brief, one-hour, five-weekly intervention, the experience of implementing it has helped to inform my primary school’s mental health and wellbeing strategy moving forward. Some areas that we are considering for the future include adapting aspects of the original game based on feedback. For example, children can create their own Beasties with different and specific sets of emotional challenges based on their own experiences. These Beasties could initiate further classroom activities on positive mental wellbeing. Another proposal is to develop pupil leadership opportunities by introducing Mental Health Ambassadors to promote mental wellbeing and teach their peers about the strategies they have learnt. Alongside this, the school aims to gather pupil voices (see Chapter 4) on mental health awareness and use this to inform school policies, placing pupils at the heart of a genuine WSA to mental health and wellbeing.
Summary and Concluding Thoughts
Collaboration and consultation with teachers are essential to properly develop school-based mental health services, staff-led programmes and WSAs. Understanding both intervention effectiveness (the ‘what’) and implementation issues (the ‘how’) is of crucial importance in the commissioning and delivery of school-based interventions (see Box 6.1 for implementation recommendations). These considerations can optimise the conditions for enhancing pupils’ mental health and wellbeing and improving learning and other outcomes. Furthermore, evidence suggests that successful intervention implementation can create a healthier school climate (Butler-Hepler, 2013). Therefore, staff who contribute to effective psychosocial programmes can also make a positive difference in the wider school environment by initiating a virtuous cycle.
Key Recommendations for Implementing School-Based Mental Health and Wellbeing Programmes.
Secure endorsement at a senior level within the school to ensure intervention delivery is prioritised, appropriate resources made available and whole-school ‘buy-in’
Reflect on what your setting would like to achieve and discuss which aspects of emotional literacy need developing in your pupils
Provide staff with a list of key indicators to help with identifying warning signs of pupils who may need support
Compose your intervention groups carefully, incorporating a clear referral system
Share information and resources to engage and educate parents about mental wellbeing
Consider how to maximise the impact after the intervention is complete
Ensure intervention evaluations include the voices of all key stakeholders including, crucially, children.
Note
The term children includes young people
Further Reading
Book of Beasties. 2023Book of Beasties. (2023). Games for growing minds. https://www.bookofbeasties.com/
Education Endowment Foundation & Early Intervention Foundation. 2019Education Endowment Foundation & Early Intervention Foundation. (2019). Improving social and emotional learning in primary schools. https://d2tic4wvo1iusb.cloudfront.net/production/eef-guidance-reports/primary-sel/EEF_Social_and_Emotional_Learning.pdf?v=1691030099
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- Prelims
- INTRODUCTION
- Chapter 1: Schools and the Mental Health Crisis: Education on the Frontline
- SECTION 1: CHILD AND ADOLESCENT MENTAL WELLBEING: THEORY, POLICY AND CRITICAL ISSUES FOR EDUCATION
- Chapter 2: Supporting Mental Health and Wellbeing in Schools: Policies and Approaches
- Chapter 3: Supporting the Support: Addressing Staff Mental Health
- Chapter 4: ‘Hear My Voice’: Children and Young People in Schools and Research
- Chapter 5: Online Support: Harnessing Technology for a Digital Generation
- SECTION 2: CASE STUDIES: SHARING GOOD PRACTICE FROM EDUCATION AND RESEARCH
- Chapter 6: Playful Pedagogies: Embedding Mental Health and Wellbeing in Primary Schools
- Chapter 7: Championing Co-Production: Developing Effective Mental Health and Wellbeing Strategies in Secondary Schools
- Chapter 8: Supporting the Mental Health and Wellbeing of Pupils with SEND in Schools
- Chapter 9: Relate, Place and Process: Creating Psychological Safety for Young People Disclosing Voice-Hearing in Educational Settings
- CONCLUSION
- Chapter 10: From Where we are Now to What Next: Concluding Thoughts and Future Directions
- Glossary
- Index